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Previous Volume 328:839-846 March 25, 1993 Number 12 Next

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ABSTRACT

Background The efficacy of electroconvulsive therapy in major depression is established, but the importance of the electrical dosage and electrode placement in relation to efficacy and side effects is uncertain.

Methods In a double-blind study, we randomly assigned 96 depressed patients to receive right unilateral or bilateral electroconvulsive therapy at either a low electrical dose (just above the seizure threshold) or a high dose (2.5 times the threshold). Symptoms of depression and cognitive functioning were assessed before, during, immediately after, and two months after therapy. Patients who responded to treatment were followed for one year to assess the rate of relapse.

Results The response rate for low-dose unilateral electroconvulsive therapy was 17 percent, as compared with 43 percent for high-dose unilateral therapy (P = 0.054), 65 percent for low-dose bilateral therapy (P = 0.001), and 63 percent for high-dose bilateral therapy (P = 0.001). Regardless of electrode placement, high dosage resulted in more rapid improvement (P<0.05). Compared with the low-dose unilateral group, the high-dose unilateral group took 83 percent longer (P<0.001) to recover orientation after seizure induction, whereas the combined bilateral groups took 252 percent longer (P<0.001). During the week after treatment, there was three times more retrograde amnesia about personal information with bilateral therapy (P<0.001). There were no differences between treatment groups in cognitive effects two months after treatment. Forty-one of the 70 patients who responded to therapy (59 percent) relapsed, and there were no differences between treatment groups.

Conclusions Increasing the electrical dosage increases the efficacy of right unilateral electroconvulsive therapy, although not to the level of bilateral therapy. High electrical dosage is associated with a more rapid response, and unilateral treatment is associated with less severe cognitive side effects after treatment. .

Source Information

From the Department of Biological Psychiatry, New York State Psychiatric Institute, and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University -- both in New York.

Address reprint requests to Dr. Sackeim at the Department of Biological Psychiatry, New York State Psychiatric Institute, 722 W. 168th St., New York, NY 10032.

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